Provider Demographics
NPI:1487796777
Name:KIRWAN, LAURENCE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ANTHONY
Last Name:KIRWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:148 EAST AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5721
Mailing Address - Country:US
Mailing Address - Phone:203-838-8844
Mailing Address - Fax:203-774-1177
Practice Address - Street 1:148 EAST AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5721
Practice Address - Country:US
Practice Address - Phone:203-838-8844
Practice Address - Fax:203-774-1177
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142977-1208200000X
CT027865208200000X
CAA38639208200000X
CO25990208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT204435524OtherTAX ID